Adolescence is marked by establishing a sense of identity, core values, a sense of one's relationship to the outside world and heightened peer relationships. In addition, there is also risk taking, impulsivity, self exploration and dramatic increase in sexuality. The dramatic increase in the use of cell phones and the Internet has additional social implications of sexting and cyberbullying. Sexting refers to the practice of sending sexually explicit material including language or images to another person's cell phone. Cyberbullying refers to the use of this technology to socially exclude, threaten, insult or shame another person. Studies of cell phone use in the 21st century report well over 50% of adolescents use them and that text messaging is the communication mode of choice. Studies also show a significant percentage of adolescents send and receive sex messaging, both text and images. This paper will review this expanding literature. Various motivations for sexting will also be reviewed. This new technology presents many dangers for adolescents. The legal implications are extensive and psychiatrists may play an important role in evaluation of some of these adolescents in the legal context. This paper will also make suggestions on future remedies and preventative actions.
In psychiatry, pregnancy introduces an element into the treatment setting that is complex and may require exploration. Often, in the psychotherapeutic relationship, the psychiatrist may use therapeutic techniques and provide no self disclosure to the patient by Tinsley (Am J Psychiatry 160(1): 27-31, 2003). The patient reveals all of their innermost thoughts. This can bring about curiosity for the patient about the clinician's life and result in asking personal questions which can at times be uncomfortable for the therapist, particularly for those still in training. This may feel like a boundary crossing which can pose a therapeutic challenge. The clinician is challenged to further enhance the therapeutic relationship and further help the patient on their journey to self exploration. While it is inevitable that patients will have reactions to their therapists, this can be played out in a number of ways, both at the conscious and unconscious level. While numerous studies have looked at the impact of the therapist's pregnancy on the patient and their treatment, there is no information about the effect of a therapist having a negative pregnancy outcome. Negative outcomes include the therapist having a miscarriage, delivering a still-born or both the therapist and baby dying. This case report describes a clinical scenario in which a psychiatry resident in training delivered a stillborn baby at 37 weeks and the impact of that on a long term psychotherapy patient.
Background: COVID-19 has impacted healthcare delivery across every setting and patient population since it began ravaging our communities in the early part of 2020. The impact of the pandemic has propelled changes in healthcare delivery incorporating new technologies and resulting at times to interruptions in care and impacting access to treatment. The aim of this study is to understand the various ways in which the COVID-19 pandemic has affected mental health overall and particularly in those with psychotic disorders who are particularly vulnerable to disruptions in their access to care and to their usual routines. There is evidence that mental health is negatively affected during epidemics and public health crises. The unique nature and scale of the COVID-19 pandemic in modern times presents an opportunity to learn more about the challenges faced by our patients and improvements that can be made in the delivery of mental health care.
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